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Neck Disorders and Their Connection to Migraines

20 Oct

It’s estimated that about 38 million American adults suffer from migraines and nine-in-ten report that to some degree, migraines affect their ability to carry out their normal social, leisure, work, and everyday activities. Unfortunately, there isn’t a one-size-fits-all treatment for migraines as the condition is not well understood and management tends to focus on lifestyle modifications to avoid potential triggers for a patient’s particular migraine profile. But what if a potential key to managing migraines wasn’t in the head at all? What if the neck had a role to play in migraine headaches?

A 2015 study found that 87% of chronic migraine headache patients also have neck pain. Compared with the non-headache sufferers the researchers questioned, individuals with migraines were roughly three-to-four times more likely to have neck pain. To highlight this relationship between the neck and migraines, a 2023 study looked at 295 migraine patients and found that more than half (51.9%) also had concurrent neck pain. Further analysis showed that migraine sufferers with concurrent neck pain reported more severe migraine symptoms, and the more disabling their neck pain, the worse their migraines. This makes some sense as the trigeminal nerve, which helps innervate the face and has been linked to migraines, exits the spinal cord through the upper cervical spine and travels into the face. In addition to irritation of the trigeminal nerve having a part to play in the migraine process, previous studies have identified a link between migraines and impaired cervical range of motion, reduced neck muscle endurance, and the presence of trigger points in the neck muscles. 

The good news is that doctors of chiropractic have a number of tools in their treatment repertoire for addressing these issues: spinal manipulation, mobilization, myofascial release, and other manual therapies to dry needling, neck-specific exercise, postural training, dietary recommendations, and more. It all depends on the patient’s unique presentation. This approach appears to be effective, as demonstrated in a recent three-armed trial that compared spinal manipulative therapy, sham manual treatment, and usual medical care after a three-month treatment period with follow-ups at three, six, and twelve months. The results favored chiropractic care at all time points. A systematic review of 13 studies published in 2022 concluded that mobilization techniques, trigger point therapy, manual lymphatic drainage, massage, and stretching techniques are each effective interventions for migraine headache patients, especially when used in combination. Other studies have demonstrated that addressing trigger points in the neck and other disorders in the cervical spine can result in reduced frequency, intensity, and duration of migraine episodes.

While managing migraines may require a comprehensive approach that includes exercise, diet, and lifestyle modifications, it’s clear that disorders of the neck can contribute to, if not be an underlying cause of, migraines and should be addressed. If you suffer from migraines, especially if you also have neck pain or stiffness, consult your doctor of chiropractic. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Headaches and a Traffic Light Prognosis System

20 Sep

The 2022 Global Burden of Disease study listed headaches as one of the most prevalent and disabling conditions worldwide, noting that more than half of adults actively suffer from headaches and nearly 5% of adults report headaches on more than 15 days per month. Because headaches come in many forms (at least 300 distinct types according to some researchers) and can be secondary to an underlying and potentially serious condition, doctors of chiropractic utilize a traffic light prognosis system when examining patient with headaches.

GREEN LIGHT: Primary and secondary headaches with musculoskeletal components. Primary headaches—a term which refers to headaches in the absence of a clear underlining caused pathology, trauma, or systemic disease—are the most common type of headache. Most often, these headaches are classified as either tension-type or migraine headaches. Secondary headaches describe headaches caused by a specific underlying medical condition (such as a metabolic disorder) or they can have a musculoskeletal origin, such as cervicogenic headache (which originate from dysfunction in the neck) or headaches associated with temporomandibular dysfunction or whiplash associated disorders. Because of the sensory input arising from the upper cervical spine, the upper neck and even the masticatory system have strong potential to play a role in the neurophysiology of both primary and secondary headaches. This explains why headaches not thought to be musculoskeletal in origin—such as migraines—can benefit from chiropractic care addressing issues present in the neck.

YELLOW LIGHT: Headaches with a strong psychological component. The current data suggests that around a fifth of migraine and a tenth of tension-type headache patients have co-occurring depression and/or anxiety. When a mood disorder is present, patients may engage in behaviors that can worsen or prolong their condition, such as physical inactivity, fear of movement, or poor coping strategies. In such cases, the patient may require co-management with a mental health professional to achieve a satisfactory outcome.

RED LIGHT: Headaches caused from a potentially dangerous pathology that requires emergent evaluation prior to the use of musculoskeletal care approaches. These are situations when headache may be a symptom of a much more serious issue like infection, cancer, or cervical artery dissection. In such instances, patients are immediately referred to emergency care before in-office treatment is provided.

If your current headache management strategy is not providing lasting relief with respect to reduced frequency, intensity, or duration, then contact your local doctor of chiropractic to see if a conservative multimodal treatment approach can be of benefit for your unique circumstances. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Correct Behaviors that Cause Upper-Cross Syndrome

25 Jun

Upper-cross syndrome (UCS) patients often demonstrate postural defects such as forward head posture, forward or rounded shoulders, and thoracic kyphosis. These postures are becoming more common as computers and device use assumes an even greater part of our lives and can lead to weakness in the muscles in the mid-back and front of the neck along with tightness of the chest muscles and the muscles in the rear of the neck. Viewing the body from the side, if you connected the groups of tight muscles with a line and did the same for the weak muscles, it would form a cross or X. 

A 2019 survey conducted by Common Sense Media revealed that 20% of eight-year-old children own a cell phone. By age eleven, more than half of kids have a phone and by their high school years, 84% own phones. As they age, kids spend more and more time on their phones, clocking in five hours a day as preteens and increasing use to more than seven hours a day during late adolescence. A 2023 study that included 45 teenagers found that 17 exhibited upper-cross syndrome with nearly half having forward head posture and four-in-five having rounded shoulders. 

Adults who spend their working day in front of the computer screen and their evenings watching TV or using electronic devices like tablets and smartphones are even more likely to have upper-cross syndrome and the musculoskeletal issues that can accompany it. In another 2023 study that included 99 office workers with neck and shoulder pain, researchers observed that 100% had rounded shoulders, 43.4% had forward head posture, and 54.3% had thoracic hyperkyphosis with muscle tightness in the pectoralis minor (100%), levator scapulae (93.0%), and upper trapezius (98.3%) muscles—all hallmarks of upper-cross syndrome. A 2014 study found that about half of office workers have neck and shoulder pain at any given time and nearly a third report persistent neck and shoulder pain. 

The good news is that upper-cross syndrome can be addressed with a combination of chiropractic care, at-home exercises/therapies, and lifestyle/work modifications. Your doctor of chiropractic may employ a variety of manual therapies to restore normal movement to the joints in the neck, upper back, and shoulders. Between visits, you may be asked to perform exercises to help restore good posture, which may include strengthening weakened muscles, like the deep neck flexors. As they will be more familiar with your unique situation, your doctor of chiropractic will be able to offer more specific advice with the aim of reducing your current pain/disability and lowering the chances for a future episode.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Cervical Spondylosis, Neck Stiffness, and Neck Pain

5 May

As we age, the shock-absorbing disks that sit between the spinal vertebrae in the neck can become dehydrated, leading to a condition known as cervical spondylosis (CS). Due to the thinning and reduced flexibility of the disks in the neck, the patient will experience a limited range of motion which they may describe as stiffness. In fact, the Mayo Clinic reports this is very common and affects about 85% of older adults. While a stiff neck can interfere with some daily activities, it’s when CS leads to neck pain that such a patient is most likely to visit their doctor of chiropractic. Why does neck pain affect CS patients when it does?

The first explanation is that CS compromises the disk’s ability to absorb energy and to flex and extend in response to external forces. Just picture how an old rubber ball that’s been left in the sun not only has less bounce but can break if it hits the ground hard enough. Likewise, a simple fall that may not have any effect on a young neck may be much more traumatic to that of an older person. Even something as mundane as sleeping in an awkward position can leave the CS patient with a sore neck. 

Another pain generator is the result of bone spurs that form in response to the vertebrae being pulled closer to one another. This bone growth can narrow the spaces in the vertebrae the spinal nerves pass through leading to both local pain and pain referred down into the upper extremities—a conditional known as cervical myelopathy. 

Currently, about 13% of adults in their third decade of life show signs of CS on X-ray. Unfortunately, with forward head posture from excessive device use that places added strain on the neck becoming more common, as well as increased obesity rates and sedentary lifestyles, there’s a great potential CS will start to become common at earlier ages. This highlights the importance of maintaining a healthy lifestyle.

When a CS patient seeks chiropractic care, their doctor of chiropractic will use information from the patient’s history, physical examination, and sometimes x-rays or other imaging tests to establish an accurate diagnosis and decide on a treatment approach. Care will typically include the application of manual therapies with at-home exercises to try and restore as much movement to the neck as possible. In more challenging cases, they may work in coordination with the patient’s medical doctor or a specialist or other healthcare provider.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org

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The Hamstring and Tension-Type Headache Connection

15 Apr

Patients with tension-type headaches (TTH) often experience neck pain and stiffness, which may be a contributing factor in their present headaches. Thus, it’s not uncommon for a doctor of chiropractic to use manual therapies and provide home exercise instruction focused on improving neck function in the effort to reduce headache frequency and intensity. It may surprise a TTH patient that care may also address areas of the body that seem unrelated to the head. For the TTH patient, they may receive treatment and be asked to perform at-home stretches to address their tight hamstrings. Why is that? 

The superficial back line is comprised of the muscles and associated tissues that start in the back of the head and run down the neck, back, and legs. These muscles work together to keep the body upright, but when there’s a problem in one part of this chain, it can lead to issues elsewhere.  Several studies have observed an association between tightness in the hamstrings—the largest muscle in the superficial chain—and tightness in the neck muscles. One study found that individuals with increased tension and shortening of the hamstrings are more likely to have neck and shoulder pain. A possible explanation is that tight hamstrings can cause the pelvis to tilt backward, which can contribute to the forward head posture—a postural fault that can place increased strain on the muscles in the back of the neck and contribute to headaches.

In a study that included 30 TTH patients, researchers split participants into two groups: one group received treatment to relax the hamstrings through a guided stretching routine in the office and the other received electrotherapy to stimulate the hamstring muscles. Both groups received instruction to perform self-myofascial release at home. Assessments conducted after four weeks of treatment revealed the hamstring relaxation group experienced greater outcomes with respect to headache-related disability, neck pain, and cervical range of motion. 

This finding highlights the importance of examining the whole patient—something chiropractors are trained to do—and not just focusing on the area of chief complaint as issues elsewhere in the body may be the underlying cause or a contributing cause to the patient’s condition. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Chiropractic Care for Older Headache and Neck Pain Patients

20 Jul

Neck pain and headaches are a leading cause of pain and suffering that affects hundreds of millions of seniors worldwide. Until recently, the use of chiropractic care for elderly adults with headaches and/or neck pain has been poorly understood. Let’s investigate the effectiveness of chiropractic care for the elderly who are affected with these conditions.

Questionnaires completed by 288 doctors of chiropractic revealed that close to a third (28.5%) of their caseload are patients over the age of 65, of which 45.5% presented with neck pain and 31.3% had co-morbid headache. For these patients, treatment typically consisted of a combination of physical (exercise training, traction, e-stim and/or ultrasound) and manual therapy treatments (spinal manipulation, mobilization, soft tissue therapies, and/or massage) applied to the thoracic and cervical spinal regions. On average, patients required nine visits to achieve a satisfactory outcome; however, migraine patients usually required two additional visits, on average.

The authors concluded that the chiropractors surveyed used well-established conservative techniques to effectively manage neck pain the elderly population. Additionally, the researchers note that 82% of the patients in the study utilized at least one additional health service to help manage their condition.

A 2017 collaborative study between the World Health Organization (WHO) and the “Lifting the Burden” campaign emphasized the importance of interdisciplinary collaboration in the management of patients with headaches. Indeed, the study cited that patients have a “clear preference” for the use of complementary and alternative treatments for headaches, of which spinal manipulation is listed as a highly effective treatment strategy. Other studies have noted that chiropractors are one of the most common provider types for patients with migraines, and nearly a third of such patients seek out chiropractic care.

While this article mainly focuses on chiropractic care for the management of neck pain and headache in older adults, patients of all ages can benefit from a multimodal approach that includes manual therapies, specific exercises, nutrition recommendations, etc. to restore normal motion to the neck, shoulders, and upper back to reduce pain and disability.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
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